Healthcare Provider Details

I. General information

NPI: 1245261924
Provider Name (Legal Business Name): ALVARADOHOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 ALVARADO RD
SAN DIEGO CA
92120-5208
US

IV. Provider business mailing address

6645 ALVARADO RD
SAN DIEGO CA
92120-5208
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-3172
  • Fax: 619-229-3273
Mailing address:
  • Phone: 619-229-3172
  • Fax: 619-229-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. HARRIS KOENIG
Title or Position: CEO
Credential:
Phone: 619-229-3172